Be Wary of Being a “Dr. House”: Relying Too Much on Intuition Is Risky

In the TV show House, Dr. Gregory House bases his diagnoses on heuristics—the use of intuition and rule-of-thumb techniques or mental short cuts. While heuristics can improve efficiency and decision-making effectiveness, this unconscious process may lead a physician to make a judgment based on the facts that most readily come to mind, rather than making a conscious decision after formally analyzing all facts. It’s important to be wary of relying too heavily on heuristics, as this could lead to negative patient outcomes and increased liability risk.

The following is from a case study: A patient presented progressive neurological symptoms and severe pain, but hospitalists based their diagnoses on heuristics and failed to consider a spinal epidural abscess (SEA). While infrequently encountered in clinical practice, SEA requires prompt diagnosis and treatment to prevent serious neurological complications. A delayed diagnosis can lead to irreversible neurological deficits. In this particular case, various hospitalists who saw the patient failed to initially order an MRI of the spine or a neurology consultation, which would have led to an appropriate diagnosis. When an MRI was finally done, it showed an epidural abscess compressing the spinal cord. After surgery, the patient remained paraplegic. Had the hospitalists been aware of the unconscious tendency toward using heuristics and had instead followed the standard of care to read nurses’ notes, review physical therapy assessments, and conduct thorough neurological examinations, it is more likely the patient would have had a timely SEA diagnosis and an increased chance to regain neurological function.

Because decision-making and problem-solving behavior in medical practice is guided by years of experience, heuristics inevitably plays a part, and that can be beneficial or harmful. Here are a few ways to avoid the risk:

  • Don’t stop at the first diagnosis. Ask, “What else could happen?” or “What else could this be?”
  • Be prepared to alter your course of treatment.
  • Consider family history when making a diagnosis.
  • Engage your extended team, including specialists, pharmacists, and physical therapists, to consult and treat the patient.
  • Always review what other care providers have noted on the patient’s chart.
  • Communicate with all providers involved in a patient’s care.
  • Use a structured communication process to communicate critical or worrisome findings.
  • Keep an open mind when there is conflicting information.
  • Always have a back-up plan.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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